Tooth wear, a progressive but gradual loss of convexity on the cusp of the tooth, does not cause premature deterioration of the dentition. However, it may evolve into pathological wear if this normal wear becomes accelerated due to abnormal endogenous or exogenous factors. The pathological wear can lead to pathological changes of pulp, impaired function, occlusal disharmony and aesthetic problems. When treating patients with pathological wear, the cause of the wear must be analyzed, and each tooth should be diagnosed individually. Additionally, the loss of the vertical occlusal dimension, as well as the appropriateness of the space for restoration, should be evaluated. These procedures can prevent the progression of the wear, limit the range of any possible restoration, and finally, allow a clinician to establish a conservative treatment plan. This case report presents a patient with pathological wear caused by bruxism, and treated with monolithic zirconia fixed dental prostheses, so as to restore the lost guidance and the collapsed tooth shape; treatment was made with an occlusal adjustment of specific teeth, which showed interference during lateral excursive movement. As the result of the treatment, the functional movement of the mandible was freed, and the recurrence of tooth wear was prevented. The pathological wear displayed by this patient was successfully treated by this conservative method, as well as a limited range of restoration, all the while ensuring functionality and aesthetically satisfying results.